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General NPI Number Information
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NPI Number | 1669653853
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Entity Type | Individual
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Provider Name | PATRICK T MORAN L.C.S.W.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 10 BOULDER CRESCENT ST 300C
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-3344
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Country | US
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Telephone | 719-930-6880
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Fax | 719-684-8367
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Provider Business Mailing Address
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Address Line | PO BOX 21
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City | CASCADE
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State | CO
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Zip | 80809
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Country | US
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Telephone | 719-930-6880
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Fax | 719-684-8367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 991210
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License Number State | CO
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